Hydronephrosis

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HydronephrosisDiag.jpg
Patient with neurogenic bladder
Patient with neurogenic bladder

Calyceal dilatation of any cause. Synonomous with pelvicaliectasis and pelvicaliceal dilatation.


Ultrasound Appearance

  • Communicating anechoic fluid-filled spaces within sinus complex
  • Renal enlargement


Mild hydronephrosis: Small separation of calyceal pattern (splaying), normal bright sinus echoes, normal parenchymal thickness

Moderate hydronephrosis: Ballooning of major and minor calyces, diminished sinus echoes, normal or thinned parenchymal thickness

Severe hydronephrosis: Massive dilatation of renal pelvis and calyces, associated with cortical thinning and loss of normal renal sinus echogenicity


Ultrasound grading

  • Grade 0: Homogeneous central renal sinus complex without separation
  • Grade 1: Separation of central sinus echoes of ovoid configuration, continuity of echogenic sinus periphery
  • Grade 2: Separation of central sinus echoes of rounded configuration, dilated calycesces connecting with renal pelvis; continuity of echogenic sinus periphery
  • Grade 3: Replacement of major portions of renal sinus; discontinuity of echogenic sinus periphery